Information and dispute resolution requirements

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  • (a) Each insurer providing coverage under a health insurance plan shall establish and maintain an accessible information service which health care providers may contact telephonically and electronically to ascertain immediately whether a patient, service or procedure is covered under the plan, and whether a patient has satisfied any deductible amounts under the plan. The health care provider may utilize this service in the event that the patient is unable to demonstrate satisfaction of deductible amounts.

  • (b) Each insurer providing coverage under a recognized health care plan shall provide each person covered by their plan a written explanation of benefits, which a patient may also use to demonstrate the satisfaction of any deductible amounts.

  • (c) Within sixty (60) days of the execution of a contract between the insurer and the employer or within sixty (60) days of the individuals enrollment in a recognized health care plan, each enrollee shall be provided with a benefit booklet or package outlining all benefits under the insurance plan.


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